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Strengthening Graduate Medical Education

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Strengthening Graduate Medical Education SPECIAL COMMUNICATION International Health Electives: Strengthening Graduate Medical Education Sidney Coupet, DO, MPH An international health elective (IHE) can be an important n 1997, the Institute of Medicine recognized the impor - component of the medical education and professional Itance of global health training for US physicians by development of a physician. It provides essential global calling for more awareness of the impact of globalization. 1 health skills that are crucial in a globalized society. Grad - In addition, in 2003 the World Federation for Medical Edu - uate medical education has an opportunity to deliver cation advocated for a more globally mobile health care such skills to our health care workforce while addressing workforce and the creation of a global health practitioner, the pending workforce shortage and the uneven distri - or one who thinks globally and acts locally. 2 These practi - bution of primary care physicians across the United tioners would have an opportunity to learn about different States. Currently, there is a call for graduate medical edu - cultures, health systems, and public health challenges of cation programs to create more training sites and to low-resource countries around the world and apply that undergo reform that will help fill residency slots and knowledge to the way they practice medicine in the United train more primary care physicians. The author proposes States. With these calls for global health initiatives, global that graduate medical education programs incorporate health education for US physicians has received increased international health electives into their accredited resi - attention, including fieldwork that takes place internation - dency programs. This addition could potentially ally. These international rotations, referred to as interna - strengthen their programs while making them more tional health electives (IHEs), 3 have become popular among appealing to qualified candidates. US physicians-in-training because of the educational and J Am Osteopath Assoc . 2012;112(12):800-804 personal advantages they provide, including the expansion of clinical knowledge, the improvement of physical exam - ination skills, and the opportunity to practice medicine in underserved and multicultural regions. 4 Both osteopathic and allopathic medical schools a r o u nd the country have well-established IHE programs, 5,6 and US medical school graduates are seeking out residency programs that also have established IHEs. 4,7,8 I recommend that graduate medical education (GME) programs that are looking to increase their number of residency slots 9 strongly consider establishing an IHE program. By offering inter - national clinical experience, GME programs could strengthen residents’ training and potentially increase the number of qualified applicants to their programs. Moreover, improving global health education for residents would help meet the global health care needs of our evolving society. 2 In the present article, I discuss the benefits and potential challenges in establishing IHEs and make the case for incorporating IHEs into GME programs. Financial Disclosures: None reported. Address correspondence to Sidney Coupet, DO, MPH, Robert Wood The Importance of an IHE Johnson Foundation Clinical Scholar Program, Department of Internal Med - icine, University of Michigan, 2800 Plymouth Rd, Building G016, Ann Arbor, An IHE provides immediate and long-term educational 3 MI 48109-0600. and personal growth for physicians. For example, E-mail: [email protected] Sawatsky et al 3 reported that physicians who participate Submitted July 1, 2012; revision received September 6, 2012; accepted Sep - in an IHE will rely more on patient history and physical tember 13, 2012. examination findings than on diagnostic testing when 800 • JAOA • Vol 112 • No 12 • December 2012 Coupet • Special Communication SPECIAL COMMUNICATION caring for patients. Other studies 10,11 have shown that IHEs research and exposure to different health care delivery sys - provide a cultural aspect to education and instill cultural tems. Additional studies are also needed to better differ - humility in physicians, a trait that is important to meeting entiate those benefits from lower resource settings. the health care needs of our increasingly diverse society. For example, a study by Campbell et al 11 showed that sur - Osteopathic GME Programs gical residents acquired improved understanding of the Graduate medical education in the United States is under - global burden of surgical diseases, global public health going a major transformation. In October 2012, the AOA, issues, and cultural sensitivity after exposure to cross-cul - the American Association of Colleges of Osteopathic tural communication. The long-term impacts of an IHE Medicine, and the Accreditation Council for Graduate are likely to benefit our health care system. For instance, Medical Education (ACGME) announced plans to discuss Miller et al 12 found that physicians who participated in an a unified accreditation system. 19 With this merger, the IHE program were more likely to choose primary care as ACGME would be the single accreditation system for all their specialty or to choose to practice in underserved com - US GME programs. However, the ACGME standards munities in the United States. 12 would recognize distinctly osteopathic competencies in International health electives also train physicians to programs currently accredited by the AOA. 20 Therefore, deal with health care in the 21st century—a more globalized the osteopathic medical profession will still be in the crit - society. 2 Moreover, in light of recent terrorist attacks and ical position of determining the future of our osteopathic natural disasters, our society is facing new medical issues medical health care workforce. The osteopathic medical and disease burdens that were once known to be problems profession has faced this challenge in recent years; the of only other nations. 13,14 For example, chronic respiratory number of osteopathic physicians in osteopathic GME diseases were associated with posttraumatic stress syn - programs increased by 50% from the 2006-2007 to the drome among rescuers and recovery workers after the 2010-2011 academic years—certainly nowhere near the World Trade Center terrorist attack on September 11, 2011, 15 number needed to address the pending physician and there was a Norovirus outbreak immediately after shortage in this country. 21 There has been a call for more Hurricane Katrina in 2005. 16 Whereas these disease burdens strategies to increase the number of osteopathic GME were unexpected and rare in the United States, they are programs to meet the growing number of graduates from more common in developing and conflict-prone nations colleges of osteopathic medicine. 9 As osteopathic GME around the world. An IHE can provide early exposure to programs look to increase their number of positions, they these disease burdens, which would be of great value to should also consider their ability to attract recent grad - our future physicians. uates. International health electives are one way in which Graduating medical students are aware of the osteopathic GME programs can attract graduates and demands of global health care and are now seeking GME ensure positions are filled. programs with established IHEs. 4 In 2009, a survey of 794 In light of the increased interest of osteopathic medical surgical residents in the United States revealed that 92% students in IHEs, colleges of osteopathic medicine are of survey respondents were interested in an IHE. 17 Addi - already attempting to meet these demands by creating tional studies 4,7,8 have suggested that graduates from US student-level international experiences either independently allopathic medical schools are using IHE as a criterion for or by means of nongovernmental organizations such as selecting their residency programs. Although we have no Doctors United For Haiti, foundations, and other types of current data on the selection criteria of graduates from medical organizations like DOCARE International. 5 osteopathic medical schools, it is likely that they too may Although there have been recommendations to osteopathic be using IHE as a deciding factor for their residency selec - GME programs on how to establish an IHE, 22 little is known tion process. about whether IHE programs are common among osteo - Although some of the personal and professional ben - pathic GME programs and whether there are challenges efits of an IHE may be acquired through rotations in and problems that are unique to osteopathic IHEs. Regard - resource-poor settings in the United States, 18 more studies less of whether one believes in the future primary care will need to be conducted to differentiate the most cost- physician shortage or the unequal geographic distribution effective means of obtaining these valuable skills. An IHE of available health care in the United States, 23 one would is unique, however, in that it provides hands-on educational certainly agree that the osteopathic medical profession is experiences for residents to learn about the global burden in a key position to address these issues, and that influ - of diseases. 11 In addition, although the present article mostly encing and training our future physicians in global health refers to the impact of IHEs that involve low-income coun - is paramount. Similar to the influences and benefits that tries, there may also be benefits to conducting IHEs in high- an IHE can have for
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